The core idea: your work picks the scheme, the desk treats everyone alike
Everyone living in Japan must join a public health insurance scheme, whatever their nationality. Most company employees join kenkō hoken (健康保険) through their employer, usually called shakai hoken (社会保険), social insurance, or shaho for short; spouses and children they support are covered as fuyō kazoku (扶養家族), dependants. Everyone else under 75 joins kokumin kenkō hoken (国民健康保険), literally 'national health insurance', or kokuho, run by the city or ward. That includes the self-employed, students, the unemployed and foreign residents staying more than three months who are not on a company scheme. At 75, people move to a separate scheme for older people.
Once you are in, the difference almost disappears. The diagram shows the three routes converging on one desk.
| Japanese | Romaji | Meaning |
|---|---|---|
| 保険は社保ですか、国保ですか。 | Hoken wa shaho desu ka, kokuho desu ka. | Is your insurance through work, or national health insurance? |
| 会社の健康保険に入っています。 | Kaisha no kenkō hoken ni haitte imasu. | I'm on my company's health insurance. |
| 夫の扶養に入っています。 | Otto no fuyō ni haitte imasu. | I'm covered as my husband's dependant. |
| 学生なので国保です。 | Gakusei na node kokuho desu. | I'm a student, so I'm on national health insurance. |
What replaced the paper card, and when
For decades the proof of membership was the hokenshō (保険証), insurance card. New ones stopped being issued on 2 December 2024, and all remaining cards expired by 1 December 2025. For a while clinics still accepted expired cards from patients who had not noticed; that allowance ended on 31 July 2026. Today you show one of two things.
The maina hokenshō (マイナ保険証) is not a new card. It is your existing My Number Card after you register it for insurance use. People without one receive a shikaku kakuninsho (資格確認書), literally 'eligibility confirmation document', from their insurer, free and without applying. Its format differs by insurer, so read the top line rather than trusting its shape.
| Item | Reading | What it is | Status in 2026 |
|---|---|---|---|
| 健康保険証 | kenkō hokenshō | The old insurance card | Expired; none issued since 2 December 2024 |
| マイナ保険証 | maina hokenshō | Your My Number Card, registered for insurance | The standard proof at reception |
| 資格確認書 | shikaku kakuninsho | Eligibility certificate from your insurer | Sent to people without a maina hokenshō |
| 資格情報のお知らせ | shikaku jōhō no oshirase | Paper notice of your insurance details | A backup, valid only together with the card |
| スマホのマイナ保険証 | sumaho no maina hokenshō | The My Number Card on a smartphone | Accepted at equipped clinics since 19 September 2025 |
At reception: what staff say and what you answer
The paper card has gone, but the word has not. Receptionists often still open with hokenshō o omochi desu ka, and they mean whatever proves your insurance. Answer with the thing you have. Reception Japanese is polite and quick; you only need short answers in desu and masu. Emergency visits and the names of hospital departments have their own guides; this is the desk of an ordinary clinic on a weekday morning. If you forget your card, practice varies: some clinics ask you to show it later that month, others charge the full amount for now and refund the difference when you bring it.
| Japanese | Romaji | Meaning |
|---|---|---|
| 保険証をお持ちですか。 | Hokenshō o omochi desu ka. | Do you have your insurance card? |
| マイナ保険証でお願いします。 | Maina hokenshō de onegai shimasu. | My Number insurance card, please. |
| 資格確認書でもいいですか。 | Shikaku kakuninsho demo ii desu ka. | Is an eligibility certificate all right? |
| あちらのカードリーダーにカードを置いてください。 | Achira no kādo rīdā ni kādo o oite kudasai. | Please place your card on the card reader over there. |
| 初めてですか。 | Hajimete desu ka. | Is this your first visit? |
| はい、初診です。 | Hai, shoshin desu. | Yes, it's my first visit. |
| 問診票にご記入ください。 | Monshinhyō ni gokinyū kudasai. | Please fill in the questionnaire. |
| マイナ保険証を忘れてしまいました。 | Maina hokenshō o wasurete shimaimashita. | I've forgotten my My Number insurance card. |
| 本日は全額のお支払いになります。 | Honjitsu wa zengaku no oshiharai ni narimasu. | Today you'll need to pay the full amount. |
The card reader, step by step
Most clinics have a kao ninshō tsuki kādo rīdā (顔認証付きカードリーダー), literally 'card reader with face authentication', beside the desk. You place the card, choose face recognition or your four-digit PIN, the same one you use at a convenience store, then answer consent screens about sharing your past medical and medication records with this clinic. The last screen says the check is complete and asks you to take your card. Screen designs vary by maker and clinic, but the order is the same.
If the reader cannot check you, because of a power cut, a broken chip or a network fault, show your card with the Mynaportal insurance screen or the printed notice of your insurance details.
| Japanese | Romaji | Meaning |
|---|---|---|
| 顔認証がうまくいきません。 | Kao ninshō ga umaku ikimasen. | The face recognition isn't working. |
| カードが読み取れないみたいです。 | Kādo ga yomitorenai mitai desu. | It seems the card can't be read. |
| マイナポータルの画面でもいいですか。 | Mainapōtaru no gamen demo ii desu ka. | Is the Mynaportal screen all right? |
| 暗証番号は4桁の数字ですよね。 | Anshō bangō wa yon-keta no sūji desu yo ne. | The PIN is the four-digit number, isn't it? |
| 同意の画面は何を選べばいいですか。 | Dōi no gamen wa nani o erabeba ii desu ka. | What should I choose on the consent screen? |
Paying: what san-wari means at the cash desk
Your share is the jiko futan (自己負担), literally 'self burden'. Wari (割) means tenths, so san-wari, 3割, is three tenths: 30 percent of the official price, with insurance paying the rest. That rate applies from school age to 69. Children below school age pay 20 percent, people aged 70 to 74 pay 20 percent, and most people aged 75 and over pay 10 percent, with higher shares for higher incomes. If one month's bills become very large, the kōgaku ryōyōhi (高額療養費), high-cost medical expense benefit, refunds the amount above a limit.
| Japanese | Romaji | Meaning |
|---|---|---|
| お会計は1,200円です。 | Okaikei wa sen-nihyaku-en desu. | That will be 1,200 yen. |
| カードで払えますか。 | Kādo de haraemasu ka. | Can I pay by card? |
| 領収書をお願いします。 | Ryōshūsho o onegai shimasu. | Could I have a receipt, please? |
| 次回の予約をお願いします。 | Jikai no yoyaku o onegai shimasu. | I'd like to book my next appointment. |
Beyond the basics: look-alike papers, job changes and expiry dates
Two papers look official and are easy to confuse. The shikaku kakuninsho stands on its own: show it and you are covered. The shikaku jōhō no oshirase (資格情報のお知らせ), notice of insurance details, is sent to people who use a maina hokenshō, and it is useless alone: it only backs up the card when the reader fails, and it must be a paper printout, not a photo on your phone.
When you leave a company you also leave its kenkō hoken, so unless a new employer enrols you, register for kokuho at the city office within 14 days. The kokuho premium is set by each municipality from last year's income, and unpaid premiums can count against you when you renew your status of residence. Finally, the My Number Card's certificates expire every five years. After expiry the card still works as insurance for three months, but only for insurance details, so renew it at the city office. At the counter after quitting, it sounds like this.
| Japanese | Romaji | Meaning |
|---|---|---|
| 会社を辞めたので、国民健康保険に入りたいです。 | Kaisha o yameta node, kokumin kenkō hoken ni hairitai desu. | I've left my company, so I'd like to join national health insurance. |
| 資格喪失証明書はお持ちですか。 | Shikaku sōshitsu shōmeisho wa omochi desu ka. | Do you have the certificate showing your old coverage ended? |
| 保険料はいつから払いますか。 | Hokenryō wa itsu kara haraimasu ka. | From when do I pay the premium? |
| 来月から新しい会社の社保に入ります。 | Raigetsu kara atarashii kaisha no shaho ni hairimasu. | From next month I'll be on my new company's insurance. |
Common mistakes at the clinic desk
- Bringing the old card. Years of habit keep it in wallets, but it expired, and the grace period ended on 31 July 2026. Carry your registered My Number Card or your certificate instead.
- Showing the notice of insurance details on its own. It looks like a certificate, but it only works together with the My Number Card.
- Entering the long signing password at the reader. The card has two certificates; the reader wants the four-digit PIN, or just your face.
- Waiting for a maina hokenshō to arrive in the post. The name suggests a new card. Register the My Number Card you already have, at a clinic reader or in the app.
- Staying uninsured after leaving a job. Nobody enrols you in kokuho automatically. Go to the city office within 14 days, taking the paper that shows your old coverage ended.